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Nursing Science Quarterly, 21:2, April 2008
References
Boswell, C., & Cannon, S. (2007). Introduction to nursing research:
Incorporating evidence-based practice. Sudbury, MA: Jones and
Bartlett.
Burns, N., & Grove, S. K. (2007). Understanding nursing research:
Building an evidence-based practice. St. Louis, MO: Elsevier.
Houser, J. (2008). Nursing research: Reading, using, and creating
evidence. Sudbury, MA: Jones and Bartlett Publishers.
Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based
practice in nursing and healthcare: A guide to best practice.
New York: Lippincott Williams & Wilkins.
Introduction to Nursing Research; Incorporating
Evidence-Based Practice, by C. Boswell & S. Cannon
(Sudbury, MA: Jones and Bartlett, 2007)
Reviewed by Gail J. Mitchell, RN; PhD
Associate Professor, York University, Toronto, Canada
A context for review of the text Introduction to Nursing
Research: Incorporating Evidence-Based Practice by Carol
Boswell and Sharon Cannon (2007) is required prior to my
commentary. As a human science nurse committed to
advancing nursing as a unique discipline, my biases and
views align with other colleagues who contend that nursing
is a knowledge-based discipline, informed by an academy of
scholars who develop and advance nursing theories in order
to inform nurses in practice and research. Therefore, my
assumptions about nursing as a profession and as a discipline
diverge, indeed oppose, the assumptions of the authors of the
text being critiqued in this column. To critique the text based
on this divergence of worldview, would, from my sense, be
counterproductive and inadequate. Therefore, I looked for a
contextual bridge to critique the text in a more meaningful
and productive way. The bridge I defined to approach the critique is that of hospital-based nursing and the need for safe,
ethical, competent, clinical healthcare. This context of safe,
ethical, competent, clinical care provided the frame for my
review and comment on the text Introduction to Nursing
Research; Incorporating Evidence-Based Practice.
Serving as a nurse leader in a large university teaching
hospital prepared me to consider the directives, views, and
values recommended in the text under review. This introductory research text was clearly written with interesting
additions to each chapter, such as summary points, red flags,
out of the box thinking, multiple choice questions, discussion questions, and additional readings. The text provided a
good basic understanding of quantitative research and
how Boswell and Cannon (2007) believed that beginning
and continuing staff nurses could conceptualize, critique,
DOI: 10.1177/0894318408315021
evaluate, and practice nursing using evidence-based
practice. The authors included some content on qualitative
research and its role in the construction of evidence, but this
content seemed like an add-on—perhaps for editorial or
political reasons—that was covered in narrow and at times,
inadequate ways.
The authors’ preface clearly stated what the text
was about: “This text understands evidence-based practice as
the combination of clinical proficiency with experimental
proof from methodological research endeavors. Baccalaureateprepared nurses must incorporate research-based knowledge
into the procedures that they follow in order to achieve holistic health care” (Boswell & Cannon, 2007, p. xiii). The key
words in the authors’ description were clinical, proficient,
experimental, proof, and procedures. These words provided
insight into the authors’ worldview and the text would have
been enhanced if the authors had focused on content in the
important areas of clinically competent, hospital-based procedures of nursing care. The problem was that there was little
about nursing care or nursing practice described in the text.
In fact, the authors ranked data bases for nurses and placed
MEDLINE as more valuable than CINAHL. Furthermore,
the authors’ attempts to cover qualitative research and holistic approaches to care acted as troubling diversions from the
central tenets of the text.
One of the most troubling diversions from the focus on
clinical care was the use of nurse-person situations that
were completely devoid of any sign of relationships with
clients—real relationships with persons suffering or experiencing change, or loss, or fear. For instance, one example
described a woman recently diagnosed with cervical cancer
who wanted to talk with the nurse about “general cancerrelated issues” (p. 13) and about the chances that her
daughters had to develop cancer. Instead of first directing
the nurse to speak with the woman and explore her concerns and fears using compassion and concern, Boswell and
Cannon (2007) recommended that the nurse initially
explore the “type of routine screening examinations that
Book Reviews and New Media
should be performed for children” (p. 13). Another example
of less than humanistic nursing care can be seen when the
authors asked the nurse to develop a researchable question
in order to drive a data search from a scenario that included
clients who were expressing anguish and guilt about dealing with their loved ones who had a terminal illness. These
examples continued in the text and exemplified, for me,
what is most troubling about this and other books that
remove nursing from its foundational relational and theoretical nature and turn it into some research process that is
objectifying and totally unrealistic. There is nothing wrong
with recommending to nurses that they may want to do a
literature search on something observed or experienced in
practice. However, the literature search has to happen in
conjunction with nurses who are grounded in nursing
theory and other forms of knowledge about how to be in
relation with others. I can picture nurses reading this text
and thinking they have to research every question a patient
poses. “Nurse, am I going to die?” Researchable question:
How many people with end-stage COPD die? The question
this text left me with was: Where is the nursing in evidencebased practice? Other substantive research texts, such as
the text by LoBiondo-Wood and Haber with Canadian editors, Cameron and Singh (2005) have managed to link
research, theory, and practice in ways that do not diminish
the nurse-person relationship, the role of theory in nursing
practice, or the important role of research and critical thinking for all nurses working in multiple settings.
Not only was the relational foundation of nursing practice
diminished or nonexistent in the text, Boswell and Cannon
(2007) clearly valued quantitative over qualitative research.
Qualitative research was ranked fourth in a hierarchy from
one to nine with randomized control trials ranked as number
one and program evaluation data ranked as number nine.
Furthermore, qualitative research was considered to be
appropriate by Boswell and Cannon only if it addressed a
problem defined by researchers in an area where little was
known. Several other serious errors concerning qualitative
research can be seen in the following quotes. “In qualitative
studies . . . researchers focus on the viewpoints of subjects
. . . to explore new concepts and ideas” (Boswell &
Cannon, 2007, p. 86). “The objectives of qualitative research
vary according to the discipline involved” (Boswell &
Cannon, 2007, p. 164). “The word qualitative implies that
one is examining the quality of something rather than the
quantity, amount, intensity or frequency . . . and this
implies a level of subjectivity (Boswell & Cannon, 2007,
p. 164). Implied in these statements is that quantitative
research does not involve a level of subjectivity and that qualitative methods depend on a disciplinary focus for definition,
whereas quantitative methods do not.
Further, in the ethics section of the book, Boswell and
Cannon (2007) suggested that qualitative research may
have “increased risk for ethical lapses” (p. 62) because of
the self-disclosure that happens in research that is never
181
value-free. This idea is contrary to what I witnessed as a
chief nursing officer where many ethical issues and
concerns linked with research were raised, but not in relation to patients’ self-disclosure but to coercion, to research
protocols that delayed treatment, and to invasive and potentially harmful interventions of randomized clinical trials.
Yet, none of these serious ethical matters were addressed by
Boswell and Cannon in their brief paragraph on the valueneutral nature of quantitative inquiry. The authors did highlight the value of qualitative research for exploring human
experiences, and in keeping with their focus on hospitalbased nursing, Boswell and Cannon offered examples of
exploring nursing burnout and turnover and using grounded
theory to explore how nurses could use vital sign data to
detect changes in patient status.
Another problem with the text involved the idea of holistic care. Boswell and Cannon (2007) defined holistic care
as: “Holistic nursing care encompasses the clinical expertise
of the nurse, patient preferences, cultural aspects, psychosocial facets, and biological components” (p. 5). However,
nowhere in the text of 350 plus pages, was there an actual
example of how practice would be changed by nurses in
light of unique client preferences, wishes, or life patterns. In
the absence of any specific examples about how tested and
confirmed evidence could be made malleable by holisticthinking nurses, it is impossible to seriously consider that
such an approach is plausible.
In addition to the troubling diversions mentioned in the
previous two paragraphs, the authors, even in the context
of clinically competent hospital-based nursing care, seriously overstepped the boundaries of professional nursing
practice, especially at the baccalaureate level. For
instance, in the introduction, the authors proposed that
information about disease management, such as asthma,
must be tested and confirmed prior to application, and
then tempered by unique client situations and wishes. No
example of tempering was offered in the text, but that is
beside the point. The point I am making here is that there
are multiple examples in the text where nursing was portrayed as a discipline of disease management based on
research. Clearly, this is a biomedical, clinical view of
nursing that might be expected if one’s view of nursing is
hospital procedures, but there was no realistic presentation of the boundary between nursing and medicine and
this is troubling in the context of the universal desire for
safe, competent, hospital-based nursing care.
References
Boswell, C., & Cannon, S. (2007). Introduction to nursing research:
Incorporating evidence-based practice. Sudbury, MA: Jones
and Bartlett.
LoBiondo-Wood, G., & Haber, J. (C. Cameron & M. D. Singh,
Eds.). (2005). Nursing research in Canada; Methods, critical
appraisal, and utilization (1st Canadian Ed.). Toronto, ON:
Elsevier Mosby.
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Nursing Science Quarterly, 21:2, April 2008
Reviewed by JoAnn Gruca, RN; PhD
Associate Professor, Saint Xavier University School of
Nursing, Chicago, Illinois
This slim text accomplished its main purpose to an
eminent degree. Boswell and Cannon’s (2007) volume entitled Introduction to Nursing Research: Incorporating
Evidence-Based Practice succeeded in providing baccalaureate nursing students and practicing clinicians with a text to
assist them to acquire a foundational understanding of nursing research through application of evidence-based practice
(EBP) to modern healthcare.
EBP is not exactly a new concept in nursing or other
health professions. Boswell and Cannon’s (2007) welldesigned table on page 8 provided a comparison of definitions and references dating from the late 1990s. Within its
367 pages, this text went beyond definitions, however, as it
consistently attempted to illuminate the principles of nursing research by frequent reference to EBP. The frequent reference to EBP will assist students in undergraduate nursing
programs as they consider the why of practice as well as the
what and the how. A second audience for this text, practicing nurses, should also be aided in the process of incorporating EBP into their practice through studying this text.
Features of the organization of Boswell and Cannon’s
(2007) book make it quite user-friendly. Each of the 14
chapters began with learner-focused behavioral objectives.
Key terms to be mastered in the chapter also appeared at the
beginning to focus the reader’s attention. Furthermore, readers were encouraged to think outside the box by brief paragraphs interspersed throughout the chapters. For example, in
the chapter on reliability and validity, we are asked to consider these characteristics in relation to the different tools that
are used on clinical units. Faculty might employ the think
outside the box questions to spur classroom discussion or to
assign as topics for short essays (Boswell & Cannon, 2007).
Standard features in Boswell and Cannon’s (2007) text
seemed to be designed to help readers synthesize and test
their mastery of important information. For example, summary points, sentences that review salient ideas in the material covered, are listed at the end of each chapter along with
multiple choice questions that help the student discern how
the subject matter just explained might be developed into
test questions. More lengthy discussion questions assist the
reader to reflect on the everyday application of research concepts. Suggested readings and references at the end of each
chapter document sources of supplementary information on
the topics discussed, including classic print-based resources
and up-to-date Web sites.
One of the most novel learning tools incorporated into
the chapters of Boswell and Cannon’s (2007) text is the red
flag alerts, pointing to confusing ideas apt to be misunderstood or forgotten by the beginning student of nursing
research. For example, it is emphasized that “tools used for
quantitative data collection should have documentation of
validity and reliability indices” (Boswell & Cannon, 2007,
p. 206). Faculty might use these red flags in discussion of
published research articles, choosing examples that demonstrate the acceptable approach.
Mastery of important principles of nursing research was
a goal that seems to have inspired the author’s development
of supplementary Web-based materials designed for student
use. The Web site accompanying Boswell and Cannon’s
(2007) text included animated flash cards, chapter objectives, interactive crossword puzzles, an interactive glossary,
and Web links. Application of EBP was emphasized in four
case studies that help to clarify the authors’ model of EBP.
Using aspects of population of interest, intervention, condition of interest, outcome, and time (PICOT) (Boswell &
Cannon, 2007), students learn how to decide about clinical
policies and procedures. Faculty (or students themselves)
might be assigned to develop case studies and PICOT analyses of situations they encounter in clinical practice.
Nursing professors teaching sections of undergraduate
research will be assisted by the supplementary faculty materials available on the book’s Web site. As is almost becoming customary today, instructor materials for the Boswell
and Cannon (2007) text include PowerPoint visuals, lecture
outlines, and answers to end-of-chapter questions (both discussion and multiple choice format).
This text could be particularly useful to two audiences:
registered nurse to bachelor of science in nursing students
and practicing clinicians not enrolled in formal education.
Registered nurses studying for baccalaureate degrees and
enrolled in the required nursing research courses will be
attracted by the book’s clear explanations and concise format. Such students will likely be convinced of the value of
understanding nursing research as “the first step in using
evidence in everyday nursing practice” (Boswell & Cannon,
2007, p. 318). Practicing clinicians should find the later
chapters of the book particularly valuable as a guide to assist
them in analyzing evidence for use in decision-making
about policies and procedures.
Undergraduate faculty should find merit in many aspects
of the book in relation to its format and content. Advanced
organizers clearly assist the professor in directing student
attention to important concepts. Thought-provoking questions
and case scenarios provide material to enliven classroom discussion. The template for documenting evidence-based practice (Boswell & Cannon, 2007) provides a format for
application of learning through homework assignments.
Evidence-based practice is here to stay! Boswell and
Cannon’s (2007) text should assist students of nursing
research in acquiring a fundamental understanding of how to
incorporate principles of EBP into their professional decision-making grounded in the research process.
References
Boswell, C., & Cannon, S. (2007). Introduction to nursing research:
Incorporating evidence-based practice. Sudbury, MA: Jones
and Bartlett.